09. Snake Envenomation and Scorpion Stings

Title: Pediatric Toxicology: Snake Envenomation & Scorpion Stings | Emergency Medicine Board Review Description: In this comprehensive 45-minute toxicology lecture tailored for Egyptian Board of Emergency Medicine trainees, we explore the pathophysiology, clinical grading, and definitive management of North American snake and scorpion envenomations. Because children receive a larger dose of venom per body weight, they exhibit severe systemic toxicity much earlier than adults. This presentation breaks down how to identify the offending species and equips providers with the life-saving knowledge to administer antivenom and supportive care safely. Topics Covered in this Lecture: Pit Vipers (Crotalids): Visual identification (triangular heads, elliptical pupils, heat-sensing pits), pathophysiology of hematotoxicity/DIC, strict pre-hospital warnings (NO tourniquets, NO incisions), and indications for CroFAB antivenom with warnings of a 96-hour resurgence. Coral Snakes (Elapidae): The "red on yellow" identification rhyme, recognizing the profound descending neurotoxicity (ptosis, drooling, rapid respiratory arrest), and the unique role of anticholinesterase inhibitors like Neostigmine. Scorpions (Bark Scorpion): Differentiating stings by intense pain without local swelling, identifying the classic "roving eyes" (chaotic conjugate saccades), and using Fentanyl for analgesia to safely avoid histamine release. Clinical Differentiation: A direct, visual comparison contrasting the physical features and distinct fang marks of Pit Vipers versus the macerated bite marks of Coral Snakes. Toxicity Grading Scales: Step-by-step breakdown of the Pit Viper Envenomation Grading (Grades 1–3) and Scorpion Toxicity Grading (Grades 1–4) algorithms.